This Adoption Profile will help determine if the adoption is in the best interest of the pet and the adopter. All applications are subject to approval by Bond County Humane Society. Please note adoption fees are non-refundable unless approved by a BCHS Officer. The minimum age for adopters is 21 years of age.
Adopting a dog is a serious commitment. Please make sure you are ready for this commitment!
First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone*
Alt Email*
Text/Pager Email*
Dog Name or Description of Dog you are interested in adopting:*
Occupation:*
Adopter's date of birth (Note: The minimum age for adopters is 21 years of age.):*
Do you rent or own your residence?* Choose one: Own Rent
If you rent, please provide Landlord's name and phone number.
How long have you lived at your residence?*
If less than 1 year, please state how long at previous address:
What type of residence do you have?* Choose one: Apartment Condo Duplex Military Housing Mobile Home Single Family Home Townhouse
How many adults in household?*
How many children in household? What are their ages and gender(s)?*
Is this pet for you and your immediate family living in the same household?
Do any family members suffer from allergies? If yes, please describe.*
How would you describe your family's lifestyle?
Are all family members in agreement about adopting a pet?
Who will be the primary caregiver for the pet?*
Do you currently have any pets? If yes, please list all the animals you have owned in the past 5 years, including deceased, lost, or re-homed.
Name and Breed of pet #1
Age of pet #1
Gender of pet #1
Is pet #1 spayed/neutered?
Do you still own pet #1?
Where is pet #1 housed?
If you no longer own pet #1, where is it now, and when did the change occur?
Provide description of Pet #1's temperament.
Name and Breed of pet #2
Age of pet #2
Gender of pet #2
Is pet #2 spayed/neutered?
Do you still own pet #2?
Where is pet #2 housed?
If you no longer own pet #2, where is it now, and when did the change occur?
Provide description of pet #2's temperament.
Name and Breed of pet #3
Age of pet #3
Gender of pet #3
Is pet #3 spayed/neutered?
Do you still own pet #3?
Where is pet #3 housed?
If you no longer own pet #3, where is it now, and when did the change occur?
Please list the following information for all other animals owned in the past 5 years: Name, Breed, Age, Gender, Spayed/Neutered, Where this pet was housed, Where this pet is now.
Do you have a regular veterinarian? NOTE: If you currently own a pet or have owned one in the past 5 years, a veterinarian reference is required to process your application. If a vet reference is not supplied, please explain.
Vet name*
Vet address
Vet phone number
The reason I cannot supply a vet reference is:
Do we have permission to contact the veterinarian identified above to obtain your current or past animal(s) vaccination, flea and heartworm prevention history?
Have you owned a pet longer than 5 years ago? If yes, please describe your previous experience.*
Why do you want to adopt a dog?*
How long has it been since you have had a puppy?*
What would you do if this dog(s) does not get along with your current pets?*
On average how many hours will the dog(s) spend alone each day? Choose one: 0-2 3-5 6-8 9+
Where will your dog be housed? Choose one: My House Bedroom Basement Fenced Yard Garage Outdoor Kennel Tie Out
Where will the dog(s) be kept when you are not home? Choose one: Crate Free Roam in House Bedroom Basement Garage Outside Other
Do you plan to crate your new dog?
Do you have a fenced-in yard?
If fenced yard, indicate height and style:
If yard is not fenced, how will you handle exercise and toilet duties for the dog?
What traits are you looking for in a dog (age, gender, temperament, etc.)?
Do you have the time, patience, love, and physical ability to exercise a dog?*
Have you ever participated in Obedience training classes? If so, please describe your experience with training and behavior programs.*
How will you correct or reprimand your dog(s)? Physical / Verbal / Other?
If you adopt a dog, will you enroll the dog in obedience classes? If not, please explain why.
What type of activities would you like to do with the dog you adopt?*
What reasons would cause you to not be able to keep the dog?*
Please provide a non-family reference, including name, phone numbers, address, and relationship to you.*
Do we have permission to contact the reference provided? If no, your application for adoption cannot be processed.
Do you agree to license this pet and give it regular health care for the life of the pet?
Do you agree to contact Bond County Humane Society if you decide not to keep this pet for any reason?
Would you be willing to allow someone designated by BCHS to visit your home by appointment? If no, please explain.*
Do you agree to abide by all applicable state, county, and municipal laws applicable to animals and their care?
Have you applied to any other shelter or rescue within the past year? If so, what was the result?*
The information on this application will be kept confidential. I certify that all the information provided above is complete and correct to the best of my knowledge. Please sign and date:*
If you have questions, please list below or contact: Bond County Humane Society, 2510 S. Elm Street, Greenville, IL 62246. Phone: 618-664-4068. Email: bchs4pets@sbcglobal.net